Whatever stage you are in the journey of infertility,its importantfor you to know how to deal with the challenges it brings to you.Sometimesmaking some decisions to continue treatment or stop treatmentaltogether could be particularly stressful.

I think it would be nice to discuss the issues surrounding this aspect of infertility this week. If you or someone you know is going through infertility,then you need to read this.

One in every six couples will never be able to conceive a child. This can be a very painful realization for a couple who has dreamed of having offspring.The family: A Proclamationto the world says We declare that God's commandment for his children to multiply and replenish the earth remains in force."

Although some couples are not biologically able to become parents, they can become parents in every other sense of the word.

The Hurt of Childlessness

Couples who are not able to have children may experience a wide spectrum of feelings—jealousy, despair, envy, isolation, and bitterness. They may feel singled out for an ordeal few others seem to experience, and they might find it difficult to fit into social circles where everyone else has children. The anguish can go so deep that seeing a baby can feel like a knife in their hearts.

Men and women tend to react somewhat differently to infertility. Women often experience profound grief and sadness. They tend to cry a lot and to reduce their anxiety by talking about what they're experiencing. Men, on the other hand, express fewer anguished feelings and seem to be less affected by being childless. They generally don't feel as free to talk about their feelings and tend to have less opportunity to discuss them with friends.

Childlessness can cause stress on a couple's personal, social, and sex lives. The anger and disappointment that often accompanies childlessness can rub off on the marital companionship, and cause couples to blame one another. Many couples suffer with depression which in turn can lead them withdraw themselves from friends and family. Going to a party or family gathering where children are present can cause the pain of childlessness to surface. As a result couples avoid these types of situations. When couples place procreation as the focus of their intimacy for an extended period of time, sexual intercourse becomes solely a way to create children; it no longer has the element of love, affection, or spontaneity.

What Can Family Members Do to Help?

Couples struggling with childlessness need support from family members and friends. However, it's important not to be intrusive into this very private dimension of a marriage. Here are a few tips to help the ones you love.

Show understanding and acceptance.

Listen without giving advice.

Let the couple know you are there for them.

Don't ask a woman if she is pregnant.

Give the couple respect and privacy.

Don't offer false hope.

Don't joke about infertility.

Don't suggest solutions, such as infertility treatments, adoption, or foster parenting. These are options that should be privately discussed between a couple.

Don't offer the commonly repeated misinformation that a woman who adopts often gets pregnant soon after.

Learn about infertility so you can be an informed listener. It helps a lot if you can listen!

WHAT CAN YOU DO AS A COUPLE IF YOU AREINFERTILE

If you’re having a hard time coping with infertility, you’re not alone. Research has shown that the psychological stress experienced by women with infertility is similar to that of women coping with illnesses like cancer, HIV, and chronic pain. Infertility is not an easy disease to cope with.

To make things worse, you may hear from friends or family that your anxiety is causing the infertility. But this is not true. While researchers once thought that stress caused infertility, more recent studies do not make this connection.

The whirlwind of emotions that infertility brings can feel overwhelming. Sometimes knowing that your feelings are normal can help.

Some of the feelings you may experience include:

·Loss: You may feel a sense of loss for the child or children you imagined having one day. You may also feel that you’re missing out on the experience of parenthood or the act of having a biological child.

·Anger and jealousy: You may feel angry at life in general. You may also feel angry or jealous that parenthood seems to come easily to others.

·Denial: You might tell yourself that you just know next month will bring a positive pregnancy test, and then, when it doesn’t, feel a huge sense of sadness and shock.

Shame: Women may feel that a diagnosis of infertility makes them less feminine, while men may feel that a diagnosis makes them less masculine. You may also feel that you are somehow less of a person if you can’t have a child on your own.

Lack of Control: You may feel a lack of control, knowing that there is nothing you can do to guarantee or know if treatments will work.

Marital or Relationship Stress

Infertility can also put stress on your relationship, with studies showing that couples dealing with infertility are more likely to feel unhappy with themselves and their marriages.

Infertility may affect your relationship in a number of ways, including:

·Sexual tension: Especially around ovulation, sex may feel more like a chore than an enjoyable way to express love for each other. Men may experience performance anxiety, leading to feelings of guilt or shame

Financial stress:Fertility treatment costs can quickly add up. Everything from deciding how much you’re willing to pay, to coping with the financial strain or debt, can create a great deal of stress between couples.

·Fear of abandonment: Especially for the partner with the infertility diagnosis, he or she may be afraid that their partner will want to leave them to have children with someone else.

Arguments about treatments: Deciding which treatments or options to try, when to stop seeking treatment, or when to take a break can put tremendous strain on a couple.

Ways to Cope

With the myriad of feelings surrounding infertility, good coping skills are essential. Here are a few tips to help manage and lower the stress of infertility:

·Acknowledge your feelings: Holding everything inside does not help. It actually takes more mental energy to hold your feelings back than to express them. Allow yourself time to feel the sadness, anger, and frustration.

·Seek support: Whether through friends, professional counseling, groups, or online forums, finding somewhere to talk with people who understand can help you feel less alone.

Talk to your partner: Talk about your feelings together. Keep in mind, though, that men and women cope with stress in different ways. Women are more likely to express their sadness, while men tend to hold things inside. Neither way is wrong, just different.

Learn as much as you can: The more you know about infertility, including alternatives like adoption or living child-free, the more in control you will feel.

Don’t let infertility take over your life: Make sure you fill your life and your relationship with other things. If it seems like infertility is all you talk about together, set a specified time each day for the topic, and use the rest of the day to talk about other things.

·Keep sex fun: As mentioned above, sex can quickly become more like a chore, than a fun way to express love for each other.Try to keep thingsloving and exciting . , play fun music, or watch romantic movies, whatever makes you both feel good.

·Consider professional help: Many couples find that professional individual or couples counseling can help them cope with the emotional stress of infertility, and some fertility clinics insist that their patients seek counseling before and during treatment.

If you find yourself feeling constantly sad or anxious, not sleeping well or oversleeping, feeling completely isolated, or having thoughts of death and dying, then it is especially importantthat you speak to your doctor about your feelings.

Your GP may carry out some of the preliminary tests and refer you on to a specialist infertility clinic or gynecologist at any stage for more thorough investigation.

A physical examination may be the first test you experience, to check for signs of infection as well as any obvious physical abnormalities that may be affecting fertility. Many investigations will then move on to hormone tests for the woman; however, most doctors will insist that the man has a semen sample analyzed before the woman goes through any of the more invasive physical tests.

Hormone tests

The levels of most of the hormones known to play a part in fertility can be checked with a simple blood test. For a woman, this test is usually carried out around Day 21 of the cycle, when the levels of hormones can indicate whether ovulation has occurred and also where any problem might lie. Hormone test levels vary and you need to discuss carefully with your doctor not only what each hormone level means on its own, but also in combination, before moving on.

Sometimes the man is tested too, as hormone problems can affect sperm production.

Semen analysis

For this test, a man will need to deliver a sample of his semen into a sterile container. A ‘good’ test will show that he is producing enough seminal fluid, that there are more than 20 million sperm per ml, that more than 40 per cent of these are moving forward and that at least 70 per cent of them are not abnormally shaped. If the sperm count is poor, another test will probably be carried out since sperm counts can vary.

If the sperm seem to ‘clump together’, further tests may be carried out to check for anti-sperm antibodies. Two additional tests may also be used: the ‘swim-up’ test, which allows the percentage of normal sperm to be established and microscopic photography, which checks the distance the sperm travel.

Post-coital test

In this test, a couple needs to have intercourse around the time of ovulation, when a woman has ‘fertile’ mucus. A sample of cervical fluid is then obtained from the cervix a few hours later and checked under a microscope to see if motile sperm are present. If a large proportion are moving through, it shows that there is no ‘hostile’ reaction taking place.

However, if sperm aren’t getting through, this test may be followed by the sperm invasion test. A sample of the woman’s fertile cervical mucus is mixed with the man’s semen and examined under a microscope to see how far the sperm penetrate into the mucus.

If they clump together and don’t move forward, or if they die off inside the mucus, this may be because one of the couple is producing antibodies to the sperm. In such cases, a ‘crossover’ test may be done, in which the man’s semen is put on a slide with someone else’s mucus and the mucus is put on a slide with someone else’s semen. This can show where the problem might lie.

Cervical mucus can also be analysed to see if it ‘ferns’ under a microscope. Ferning is a characteristic pattern of fertile mucus and shows whether it is as stretchy as it needs to be to let sperm through.

Physical investigations

Sometimes a woman will know that she has had an infection which may have caused damage to her fallopian tubes, sometimes she won’t. Chlamydia, for example, sometimes produces no discernible symptoms, so the fact that it has damaged the tubes may come as a complete surprise. This is why a check on the state of the fallopian tubes is essential in any investigation of infertility, and there are several ways in which this can be done.

Laparoscopy test

In a laparoscopy, carried out under general anaesthetic, a viewing tube is inserted through a small incision in the woman’s abdomen. The abdomen is inflated with carbon dioxide, which makes it easier for the surgeon to check the uterus, ovaries and fallopian tubes for structural abnormalities, endometriosis and adhesions, as well as possibly repair any problems at the same time. Some surgeons also use a laparoscopy to assess whether the fallopian tubes are open: dye is injected through the cervix and should flow out of the ends of the tubes; if it doesn’t, they are blocked.

A laparoscopy is usually carried out as a day procedure, but it carries the small risks and potential side effects of any operation which requires a general anaesthetic. Some women take several days to recover and can suffer soreness as the carbon dioxide tries to escape again. Despite these drawbacks, the procedure can provide a great deal of useful information, and the tiny scar will fade.

X-ray Test (hysterosalpingography)

Another standard test to assess whether the fallopian tubes are open is hysterosalpingography. Dye is injected through the woman’s cervix into the uterus. This dye shows up on X-rays, so a series of X-rays is taken to check how it is flowing through the fallopian tubes and whether there are any blockages.

Any problems show up immediately, which makes this a useful procedure, but it can cause mild to severe cramps. Another advantage of this test is that you avoid having to have a general anesthetics and surgery; it is usually done in the hospital’s X-ray department and you can go home soon afterwards, though you may need someone to drive you.

Ultrasound tests (hysterosalpingo-contrast sonography)

A relatively new test for assessing whether the fallopian tubes are open is hysterosalpingo-contrast sonography. A contrast solution is injected through the cervix and ultrasound scanning allows its flow along the tubes to be traced. The procedure takes between 15 and 30 minutes and you can go home straight afterwards. However, it is not suitable for everyone and a laparoscopy may also be recommended for a full assessment of your pelvic cavity.

Ultrasound scanning

Ultrasound scanning is also sometimes used as a diagnostic test. Abdominal ultrasound can give a picture of a woman’s uterus and ovaries and show any fibroids, uterine abnormalities or polycystic ovaries. Ultrasound can also monitor whether eggs are developing and being released from the ovaries. One uncomfortable aspect of abdominal ultrasound is that a full bladder is necessary to allow the ovaries to be seen more clearly. Sometimes transvaginal ultrasound is used and a full bladder is then not needed.

For a man, ultrasound can show whether the sperm are being stored and passed on through the system as they should be.

Endometrial biopsy

If there is doubt whether a woman’s endometrium (lining of the womb) is thickening as it should be in preparation for a developing embryo, an endometrial biopsy can be undertaken. A catheter is inserted through the cervix and a small sample (biopsy) of the uterine lining removed. If the endometrium has not developed as expected for that phase of your cycle, this can indicate a problem with hormone levels. The test can also be used to check for infection and if this is discovered a D&C (dilatation and curettage of the endometrium under general anaesthetic) may be needed.

Surgical exploration of the testes

This is done if no other reason can be found for a man’s infertility. It can check for blockages or infections, and a biopsy may be taken to check whether sperm are being produced and are maturing properly. If the sperm-producing tubules and the sperm in them are normal but a semen analysis shows no sperm, the problem is likely to be a blockage. A vasogram may be performed to pinpoint the blockage: dye is injected and X-rays will outline the ducts and pinpoint any obstructions.

What next?

After one, two or several of the tests, you will be told one of three things:

There is definitely something wrong (for example the man is producing no sperm). You won’t be able to get pregnant without treatment which will try to cure or get round the problem. You can then decide whether you want to go ahead with treatment.

Something is having a mild effect on your fertility (like irregular ovulation or endometriosis) but you could still get pregnant without intervention, although it may take a little longer. In this case, the process of weighing up the costs and benefits of possible treatments is more difficult.

Your infertility is ‘unexplained’ - there is no apparent physical or hormonal cause. You could still conceive, but you may not. If you have unexplained infertility it doesn’t mean there isn’t a reason why you’re not conceiving, just that doctors haven’t been able to identify it yet. This sort of infertility can often be treated successfully through techniques such as IVF, which may bypass whatever the hidden problem is.

Different causes of infertility require different approaches and you need to decide whether you want to go ahead with treatment at all and, if so, consider which treatments are available on the NHS and which treatments you could access as private patients.

NHS or private?

What will be available to you on the NHS depends on where you live. Many health authorities make no funding available for infertility treatment. In other areas, what is available will be strictly rationed; for example, drug treatment may be available but nothing else or, if your health authority does fund IVF, it may only be available to married couples under 35. Your Community Health Council will have a list of the criteria for treatment in your area.

However, even if your health authority considers you eligible for treatment, there are financial implications, including the hidden costs of taking time off work and travel expenses (you may need to make very many journeys to the clinic). You also need to remember that waiting several months for an appointment is not unusual.

One of the main advantages of private treatment is that, if you have the ability to pay, you can by-pass NHS waiting lists as long as you conform to the clinic’s own eligibility criteria. If your GP will agree to fund the costs of the drugs you will need, this can mean the difference between being able to go ahead or not. It is worth asking if your GP will do this, as many will. If you have a private health scheme, ask if your insurance will fund any part of the investigations or treatment.

It is important to take time out as a couple once you know the results of the initial tests to consider the emotional and the financial implications of treatment. Your GP can put you in touch with a counsellor if you want to talk things through, and you will be offered counselling if you’ve been referred for IVF or treatment involving donor eggs or sperm. Whether you decide to go ahead with treatment or not must ultimately be your own decision.

A smear test is a simple examination to check the wellness of a woman’s cervix. It is called a smear test (or Pap smear) because the doctor or nurse takes a small sample of cervical cells and smears them onto a glass slide to be analysed under a microscope. If abnormal cells are found, in many cases they will go back to normal on their own, but sometimes they continue to develop. If left untreated, these cells may eventually develop into cancer. However, it usually takes more than ten years for this to happen, and cervical cancer can easily be prevented if abnormal changes are found and treated early.

The Department of Health recommends that women between the ages of 20 and 64 should have routine cervical smears every three to five years. It is best to keep your own personal records of test dates and results so you can know when you are next due for screening.

Statistics show that a woman’s risk of cervical cancer is cut by 84% if she has a smear test every five years, and 91% if she has a smear every three years. Some recommendations suggest women should have annual smear tests to reduce the risk even further (an additional 1-2%), but in the UK, you will need to go to a private clinic if you would like to have yearly smear tests. Private clinics offer cervical smears for about £60.

There is disagreement about whether or not women who are under 20, and are sexually active, should have smear tests. While teenagers may be exposed to sexually transmitted infections, severe cervical abnormalities and cancer are extremely rare in women under the age of 20. In addition, the cervical cells of teenage girls may still be developing, and this can make it difficult to tell if cell changes are a natural part of the growth process or are pre-cancerous. Some GPs and clinics will not offer smear tests to women under 20, but others may. If you are under 20 and are concerned about your sexual health, talk to your doctor or nurse practitioner. If you don’t want to tell your GP that you’re sexually active, contact a well-woman, family planning or sexual health clinic.

You can have a smear test at your local GP surgery or at a sexual health, family planning, GUM or well-woman clinic. Most smear tests are done by female doctors or nurse practitioners, but if you want to be sure the person taking your smear sample is a woman, make your preference clear when you make your appointment. When a male doctor or nurse does a smear, it is generally recommended that a female assistant be in the room as well.

It’s best to try to schedule your smear test for the middle of your menstrual cycle – about half way between one period and the next. It’s easiest to get a good cell sample from your cervix at this time. A smear cannot be taken during your period because it’s too difficult to get an adequate sample of cells, so keep this in mind when scheduling your appointment.

Before your smear

Don’t have sexual intercourse in the 24 hours before your smear test. Sperm, spermicidal gel, and lubricants may make it difficult to get a good sample of cells. If you are using vaginal pessaries to treat an infection, don’t have a smear test for at least a week after treatment has finished.

If you use a vaginal oestrogen cream for menopause symptoms, do not apply it on the day of your smear.

Do not douche or use a tampon for at least two days before your smear.